America’s Germ Capitals: The Cities Where You’re Most Likely to Get Sick

As flu season looms, Americans are gearing up for the inevitable rise in illnesses—from sniffles and sneezes to full-blown flu cases. While some cities are protected with well-established healthcare systems and cleaner environments, others face heightened risks due to a combination of environmental and lifestyle factors in the colder months.  

To anticipate the cities that may be more susceptible to illness breakouts, Soliant Health conducted an extensive study of America’s 100 most populous cities to determine where people are most—and least—likely to get sick. The comprehensive index evaluates factors such as air quality, cold and flu activity, asthma rates, seasonal pollen allergies, and public transportation germs. These factors combine to create an overall “germ score,” highlighting the most illness-prone areas across the U.S.  

While the colder months typically see an uptick in illnesses, our findings suggest that the risk of getting sick is far from evenly distributed. Explore America’s germ hotspots below to prepare for this year’s flu season! 

America’s Top Illness-Prone Cities

From air quality to public transportation germs and everything in between, we’ve ranked the top U.S. cities where you’re most likely to catch a cold (or worse). Find out how your city ranks in the list below: 

Rank	City	Sickness Score
1	Bakersfield, CA	59.10
2	Fresno, CA	57.89
3	San Diego, CA	57.64
4	New York, NY	54.76
5	Jackson, MS	53.08
6	New Orleans, LA	53.06
7	Memphis, TN	52.55
8	Augusta, GA	52.46
9	Baltimore, MD	51.99
10	Sacramento, CA	51.58
11	Los Angeles, CA	51.08
12	Baton Rouge, LA	51.07
13	Stockton, CA	50.40
14	Nashville, TN	49.97
15	Birmingham, AL	48.76
16	Philadelphia, PA	48.53
17	Riverside, CA	48.34
18	Columbia, SC	48.29
19	Boston, MA	48.22
20	Albuquerque, NM	47.93
21	San Francisco, CA	47.35
22	Houston, TX	47.25
23	Springfield, MA	46.91
24	Knoxville, TN	46.78
25	Hartford, CT	46.68
26	Toledo, OH	46.60
27	Dallas, TX	46.33
28	Spokane, WA	46.07
29	Washington, D.C.	45.95
30	Greenville, SC	45.94
31	Worcester, MA	45.93
32	Denver, CO	45.83
33	Dayton, OH	45.60
34	Providence, RI	45.42
35	Winston-Salem, NC	45.22
36	New Haven, CT	44.87
37	Detroit, MI	44.77
38	Pittsburgh, PA	44.31
39	Buffalo, NY	44.22
40	Atlanta, GA	44.18
41	Cincinnati, OH	44.07
42	McAllen, TX	43.87
43	Bridgeport, CT	43.77
44	Cleveland, OH	43.77
45	Milwaukee, WI	43.69
46	Durham, NC	43.63
47	Rochester, NY	43.59
48	Chicago, IL	43.56
49	Greensboro, NC	43.49
50	Richmond, VA	43.32
51	Indianapolis, IN	43.23
52	Albany, NY	43.21
53	Tulsa, OK	43.07
54	Charlotte, NC	42.99
55	Colorado Springs, CO	42.97
56	Charleston, SC	42.96
57	Oklahoma City, OK	42.95
58	Little Rock, AR	42.75
59	Raleigh, NC	42.70
60	Poughkeepsie, NY	42.32
61	San Antonio, TX	42.24
62	Louisville, KY	42.18
63	Portland, OR	41.74
64	Las Vegas, NV	41.54
65	Syracuse, NY	41.08
66	El Paso, TX	40.36
67	Wilmington, NC	40.01
68	Harrisburg, PA	39.60
69	San Jose, CA	39.55
70	Akron, OH	39.34
71	St. Louis, MO	39.29
72	Seattle, WA	39.25
73	Allentown, PA	39.07
74	Scranton, PA	38.95
75	Kansas City, MO	38.91
76	Virginia Beach, VA	38.59
77	Phoenix, AZ	38.57
78	Columbus, OH	38.28
79	Austin, TX	38.20
80	Jacksonville, FL	38.20
81	Wichita, KS	37.97
82	Palm Bay, FL	37.90
83	Lakeland, FL	37.81
84	Daytona Beach, FL	37.12
85	Tampa, FL	36.57
86	Orlando, FL	35.19
87	Salt Lake City, UT	34.87
88	Sarasota, FL	34.81
89	Madison, WI	34.57
90	Miami, FL	34.16
91	Des Moines, IA	34.15
92	Grand Rapids, MI	34.06
93	Fort Myers, FL	33.58
94	Ogden, UT	33.27
95	Tucson, AZ	33.23
96	Provo, UT	32.48
97	Minneapolis, MN	28.78
98	Boise, ID	27.91
99	Omaha, NE	27.76
100	Honolulu, HI	12.29

Top 5 Illness Hotspots

Here’s a breakdown of the top five cities where you might want to stock up on hand sanitizer and tissues: 

1. Bakersfield, CA 

Topping the list, Bakersfield suffers from high cold and flu activity, poor air quality, and significant asthma prevalence. Its combination of environmental and health stressors is a perfect recipe for a sniffle-filled season. 

2. Fresno, CA 

Right behind Bakersfield is Fresno, where the combination of bad air and allergy triggers means you might be dealing with more than just the flu—think watery eyes and lots of sneezing, too. 

3. San Diego, CA 

Known for its pleasant climate, San Diego surprisingly ranks third on the illness-prone cities list due to high cold and flu activity and elevated allergy rates. Despite its coastal location, poor air quality also contributes to its high illness score. 

4. New York, NY 

New York’s infamous subway system serves up a mix of public transport germs and close-contact environments, making it a petri dish of illnesses. The city also ranked relatively high for asthma and allergy prevalence. 

5. Jackson, MS 

Jackson’s allergy-triggering pollen and cold and flu activity makes it a top five—with a notably high asthma rate as well.  

More Sickening Findings 

Top Germ-Free Cities 

With low cold and flu activity and excellent air quality, Honolulu, HI, stands out as the safest city in the U.S. in terms of illness exposure. Omaha, NE, and Boise, ID, are the second and third safest cities from sicknesses, respectively. Omaha’s low rates of asthma and high air quality and Boise’s relatively low allergy and cold and flu activity make them some of the best cities for avoiding illness.   

California’s dominance  

Four of the top ten illness-prone cities are in California, driven by a combination of poor air quality, significant cold and flu activity, and high asthma rates. This reflects a troubling overlap of environmental and health challenges in the state’s urban areas. 

Urban vs. rural risks 

Large metropolitan areas with extensive public transportation networks—like New York City and Boston—experience heightened risks due to germ exposure in densely populated areas. 

Impact of air quality 

Cities with the worst air quality, such as Bakersfield and Fresno, consistently rank higher in illness likelihood, demonstrating the impact air quality can have on respiratory and immune systems. 

Staying Healthy—Wherever You Live 

While these cities may be hotspots for germs, staying vigilant can go a long way. From boosting your immune system to keeping up those healthy habits, it’s all about finding balance—even in the most illness-prone places. So, whether you’re in Bakersfield or Honolulu, a little extra effort could make this flu season a whole lot more bearable. 

While environmental conditions are significant, access to quality healthcare is just as important for managing illness risks in America’s germ capitals. Learn more about the importance of access to qualified healthcare professionals at Soliant Health, and explore opportunities in cities that need you most! 

Sources & Methodology  

To most accurately calculate the final ranking, a range of values for each category was established and used to create a scale. Cities were evaluated based on their performance within these scales, receiving a calculated value for each category. These adjusted values determined how each city ranked across all categories. The weighted values from all five categories were summed to determine the final ranking, with each category contributing an equal 20% toward a total possible score of 100. The factors and sources utilized include: 

• Air Pollution: Highest annual average concentration of PM2.5. Source: U.S. Environmental Protection Agency (EPA). 

• Illness Activity: The activity level of visits for a respiratory illness that includes fever plus a cough or sore throat during 2023-24 Influenza Season (week 48). Source: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD). 

• Asthma: Prevalence of asthma among adults. Source: Centers for Disease Control and Prevention. Environmental Public Health Tracking Network. 

• Public Transport Germs: Value reflecting potential germ exposure from close-contact and high-traffic public transportation environments, derived by comparing the total number of commuters to daily public transportation commuters. Source: U.S. Census Bureau, American Community Survey, 2022 ACS 5-Year Estimates Detailed Tables, Table B08301. 

• Allergies: The city’s allergy prevalence score, according to the Asthma and Allergy Foundation of America. Source: Asthma and Allergy Foundation of America. 2023 Allergy Capitals. 2024 Allergy Capitals. 

Allergy data not available for Honolulu, HI. Honolulu’s score is based on the other four categories with a 25% weight and a total possible score of 100. 

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